{"id":16926,"date":"2020-11-01T23:16:45","date_gmt":"2020-11-01T23:16:45","guid":{"rendered":"https:\/\/municipalitedebury.qc.ca\/en\/?page_id=16926"},"modified":"2022-05-06T14:32:22","modified_gmt":"2022-05-06T14:32:22","slug":"complaint-form","status":"publish","type":"page","link":"https:\/\/municipalitedebury.qc.ca\/en\/complaint-form\/","title":{"rendered":"COMPLAINT AND DEMAND FORM"},"content":{"rendered":"<div id=\"quform-b5e4be\" class=\"quform quform-1 quform-theme-react quform-support-page-caching\"><form id=\"quform-form-b5e4be\" class=\"quform-form quform-form-1\" action=\"\/en\/wp-json\/wp\/v2\/pages\/16926#quform-b5e4be\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-options=\"{&quot;id&quot;:1,&quot;uniqueId&quot;:&quot;b5e4be&quot;,&quot;theme&quot;:&quot;react&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:[],&quot;dependents&quot;:[],&quot;elementIds&quot;:[],&quot;dependentElementIds&quot;:[],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;&quot;,&quot;updateFancybox&quot;:true,&quot;hasPages&quot;:false,&quot;pages&quot;:[1],&quot;pageProgressType&quot;:&quot;numbers&quot;,&quot;tooltipsEnabled&quot;:true,&quot;tooltipClasses&quot;:&quot;qtip-quform-dark qtip-shadow&quot;,&quot;tooltipMy&quot;:&quot;left center&quot;,&quot;tooltipAt&quot;:&quot;right center&quot;,&quot;isRtl&quot;:false,&quot;scrollOffset&quot;:-50,&quot;scrollSpeed&quot;:800}\"><button class=\"quform-default-submit\" name=\"quform_submit\" type=\"submit\" value=\"submit\" aria-hidden=\"true\" tabindex=\"-1\"><\/button><div class=\"quform-form-inner quform-form-inner-1\"><input type=\"hidden\" name=\"quform_form_id\" value=\"1\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"b5e4be\" \/><input type=\"hidden\" name=\"quform_count\" value=\"1\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/municipalitedebury.qc.ca\/en\/wp-json\/wp\/v2\/pages\/16926\" \/><input type=\"hidden\" name=\"referring_url\" value=\"\" \/><input type=\"hidden\" name=\"post_id\" value=\"\" \/><input type=\"hidden\" name=\"post_title\" value=\"\" \/><input type=\"hidden\" name=\"quform_current_page_id\" value=\"1\" \/><input type=\"hidden\" name=\"quform_loaded\" value=\"1792788515|5e51242baedb3b4da086ad7b0b00bb12\" \/><input type=\"hidden\" name=\"quform_csrf_token\" value=\"YKYLhoBNydhBvMqI9PDQG00iZxWgobjALKl3bgWE\" \/><div class=\"quform-form-title-description\"><h2 class=\"quform-form-title\">COMPLAINT FORM<\/h2><\/div><div class=\"quform-elements quform-elements-1 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-element quform-element-page quform-page-1 quform-page-1_1 quform-cf quform-group-style-plain quform-first-page quform-last-page quform-current-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-textarea quform-element-1_641379 quform-sr-only quform-cf\" style=\"clip: rect(1px, 1px, 1px, 1px); clip-path: inset(50%); position: absolute !important; height: 1px; width: 1px; overflow: hidden;\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-1_641379\"><label class=\"quform-label-text\" for=\"quform_1_641379_b5e4be\">Contact Email<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-1_641379\"><textarea id=\"quform_1_641379_b5e4be\" name=\"quform_1_641379\" class=\"quform-field quform-field-textarea quform-field-1_641379\" tabindex=\"-1\" autocomplete=\"new-password\"><\/textarea><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-1_3 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Identification<\/h4><\/div><div class=\"quform-child-elements\"><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-1_4 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-1_5\"><div class=\"quform-element quform-element-text quform-element-1_7 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-1_7\"><label class=\"quform-label-text\" for=\"quform_1_7_b5e4be\">Last name<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-1_7\"><div class=\"quform-input quform-input-text quform-input-1_7 quform-cf\"><input type=\"text\" id=\"quform_1_7_b5e4be\" name=\"quform_1_7\" class=\"quform-field quform-field-text quform-field-1_7\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-1_9 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-1_9\"><label class=\"quform-label-text\" for=\"quform_1_9_b5e4be\">First name<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-1_9\"><div class=\"quform-input quform-input-text quform-input-1_9 quform-cf\"><input type=\"text\" id=\"quform_1_9_b5e4be\" name=\"quform_1_9\" class=\"quform-field quform-field-text quform-field-1_9\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-1_10 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-1_10\"><label class=\"quform-label-text\" for=\"quform_1_10_b5e4be\">Phone<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-1_10\"><div class=\"quform-input quform-input-text quform-input-1_10 quform-cf\"><input type=\"text\" id=\"quform_1_10_b5e4be\" name=\"quform_1_10\" class=\"quform-field quform-field-text quform-field-1_10\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-textarea quform-element-1_16 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-1_16\"><label class=\"quform-label-text\" for=\"quform_1_16_b5e4be\">DESCRIPTION<\/label><\/div><div class=\"quform-inner quform-inner-textarea quform-inner-1_16\"><div class=\"quform-input quform-input-textarea quform-input-1_16 quform-cf\"><textarea id=\"quform_1_16_b5e4be\" name=\"quform_1_16\" class=\"quform-field quform-field-textarea quform-field-1_16\"><\/textarea><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-1_6\"><div class=\"quform-element quform-element-text quform-element-1_13 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-1_13\"><label class=\"quform-label-text\" for=\"quform_1_13_b5e4be\">Address<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-1_13\"><div class=\"quform-input quform-input-text quform-input-1_13 quform-cf\"><input type=\"text\" id=\"quform_1_13_b5e4be\" name=\"quform_1_13\" class=\"quform-field quform-field-text quform-field-1_13\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-1_11 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-1_11\"><label class=\"quform-label-text\" for=\"quform_1_11_b5e4be\">Courriel<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-1_11\"><div class=\"quform-input quform-input-text quform-input-1_11 quform-cf\"><input type=\"text\" id=\"quform_1_11_b5e4be\" name=\"quform_1_11\" class=\"quform-field quform-field-text quform-field-1_11\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-1_15 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-1_15\"><label class=\"quform-label-text\" id=\"quform_1_15_b5e4be_label\">DEPARTMENT CONCERNED<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-1_15\"><div class=\"quform-input quform-input-radio quform-input-1_15 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_1_15_b5e4be_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_1_15\" id=\"quform_1_15_b5e4be_1\" class=\"quform-field quform-field-radio quform-field-1_15 quform-field-1_15_1\" value=\"PUBLIC WORKS\" \/><label for=\"quform_1_15_b5e4be_1\" class=\"quform-option-label quform-option-label-1_15_1\"><span class=\"quform-option-text\">PUBLIC WORKS<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_1_15\" id=\"quform_1_15_b5e4be_2\" class=\"quform-field quform-field-radio quform-field-1_15 quform-field-1_15_2\" value=\"WATERWORKS \" \/><label for=\"quform_1_15_b5e4be_2\" class=\"quform-option-label quform-option-label-1_15_2\"><span class=\"quform-option-text\">WATERWORKS <\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_1_15\" id=\"quform_1_15_b5e4be_3\" class=\"quform-field quform-field-radio quform-field-1_15 quform-field-1_15_3\" value=\"ANIMALS\" \/><label for=\"quform_1_15_b5e4be_3\" class=\"quform-option-label quform-option-label-1_15_3\"><span class=\"quform-option-text\">ANIMALS<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_1_15\" id=\"quform_1_15_b5e4be_4\" class=\"quform-field quform-field-radio quform-field-1_15 quform-field-1_15_4\" value=\"GARBAGE\" \/><label for=\"quform_1_15_b5e4be_4\" class=\"quform-option-label quform-option-label-1_15_4\"><span class=\"quform-option-text\">GARBAGE<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_1_15\" id=\"quform_1_15_b5e4be_5\" class=\"quform-field quform-field-radio quform-field-1_15 quform-field-1_15_5\" value=\"SEWER\" \/><label for=\"quform_1_15_b5e4be_5\" class=\"quform-option-label quform-option-label-1_15_5\"><span class=\"quform-option-text\">SEWER<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_1_15\" id=\"quform_1_15_b5e4be_6\" class=\"quform-field quform-field-radio quform-field-1_15 quform-field-1_15_6\" value=\"RECYCLING\" \/><label for=\"quform_1_15_b5e4be_6\" class=\"quform-option-label quform-option-label-1_15_6\"><span class=\"quform-option-text\">RECYCLING<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_1_15\" id=\"quform_1_15_b5e4be_7\" class=\"quform-field quform-field-radio quform-field-1_15 quform-field-1_15_7\" value=\"ENVIRONMENT\" \/><label for=\"quform_1_15_b5e4be_7\" class=\"quform-option-label quform-option-label-1_15_7\"><span class=\"quform-option-text\">ENVIRONMENT<\/span><\/label><\/div><div 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